Health Care Avoidance and Delay in the Transgender Population: A Systematic Review Exploring Associations with Minority Stress.

Purpose: A wide body of research explores the substantial issue of health care avoidance and delay (HAD) in the transgender population, and much focus has been given to the minority stress model in the exploration of associated factors. This review addresses gaps in the literature by investigating the cumulative evidence for association between HAD and minority stress, and by further examining the evidence for individual facets of minority stress. A secondary aim of this review is to examine how operationalization of HAD may impact our understanding of research findings. Methods: Five databases were searched using inclusion and exclusion criteria. Four reviewers participated in screening at title and abstract, and full-text stages. Due to heterogeneity of methodology, findings were addressed through narrative synthesis. Results: Eighteen studies explored association between HAD and factors related to minority stress: Distal stressors in health care settings, general distal stressors, distal stressors related to structural and societal factors, and proximal stressors. Findings indicate evidence for association between HAD and many minority stress factors, most notably for a range of distal stressors in health care settings. However, results in some areas reveal sparse research on a wide range of variables and studies based on the same data sources. Mediation and moderation analyses are also underinvestigated in this area, while HAD measurement is characterized by binary operationalization. Conclusion: This review underscores the importance of research that examines associations between HAD and minority stress factors in the transgender population and provides directions for future research to address gaps in current understanding.